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      Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation

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          Abstract

          Background

          Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia.

          Methods

          We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities.

          Results

          In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs.

          Conclusions

          Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia’s essential health services package.

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          Most cited references28

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          Estimating health opportunity costs in low-income and middle-income countries: a novel approach and evidence from cross-country data

          The economic evaluation of healthcare interventions requires an assessment of whether the improvement in health outcomes they offer exceeds the improvement in health that would have been possible if the additional resources required had, instead, been made available for other healthcare activities. Therefore, some assessment of these health opportunity costs is required if the best use is to be made of the resources available for healthcare. This paper provides a framework for generating country-specific estimates of cost per disability-adjusted life year (DALY) averted ‘thresholds’ that reflect health opportunity costs. We apply estimated elasticities on mortality, survival, morbidity and a generic measure of health, DALYs, that take account of measures of a country’s infrastructure and changes in donor funding to country-specific data on health expenditure, epidemiology and demographics to determine the likely DALYs averted from a 1% change in expenditure on health. The resulting range of cost per DALY averted ‘threshold’ estimates for each country that represent likely health opportunity costs tend to fall below the range previously suggested by WHO of 1–3× gross domestic product (GDP) per capita. The 1–3× GDP range and many other previous and existing recommendations about which interventions are cost-effective are not based on an empirical assessment of the likely health opportunity costs, and as a consequence, the health effects of changes in health expenditure have tended to be underestimated, and there is a risk that interventions regarded as cost-effective reduce rather than improve health outcomes overall.
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            Advancement of global health: key messages from the Disease Control Priorities Project.

            The Disease Control Priorities Project (DCPP), a joint project of the Fogarty International Center of the US National Institutes of Health, the WHO, and The World Bank, was launched in 2001 to identify policy changes and intervention strategies for the health problems of low-income and middle-income countries. Nearly 500 experts worldwide compiled and reviewed the scientific research on a broad range of diseases and conditions, the results of which are published this week. A major product of DCPP, Disease Control Priorities in Developing Countries, 2nd edition (DCP2), focuses on the assessment of the cost-effectiveness of health-improving strategies (or interventions) for the conditions responsible for the greatest burden of disease. DCP2 also examines crosscutting issues crucial to the delivery of quality health services, including the organisation, financial support, and capacity of health systems. Here, we summarise the key messages of the project.
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              Hepatitis B vaccines.

              (2009)
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                Author and article information

                Contributors
                tess_soul@yahoo.com
                Journal
                Cost Eff Resour Alloc
                Cost Eff Resour Alloc
                Cost Effectiveness and Resource Allocation : C/E
                BioMed Central (London )
                1478-7547
                22 July 2020
                22 July 2020
                2020
                : 18
                : 23
                Affiliations
                [1 ]GRID grid.7123.7, ISNI 0000 0001 1250 5688, Department of Pediatrics and Child Health, College of Health Sciences, , Addis Ababa University, ; Addis Ababa, Ethiopia
                [2 ]GRID grid.7914.b, ISNI 0000 0004 1936 7443, Department of Global Public Health and Primary Care, , University of Bergen, ; Bergen, Norway
                [3 ]GRID grid.460724.3, Department of Internal Medicine, , St. Paul’s Hospital Millennium Medical College, ; Addis Ababa, Ethiopia
                [4 ]GRID grid.30820.39, ISNI 0000 0001 1539 8988, Department of Pediatrics and Child Health, College of Health Sciences, , Mekelle University, ; Mekelle, Ethiopia
                [5 ]GRID grid.414835.f, Federal Ministry of Health of Ethiopia, ; Addis Ababa, Ethiopia
                [6 ]GRID grid.411903.e, ISNI 0000 0001 2034 9160, Department of Epidemiology, Public Health faculty, , Jimma University, ; Jimma, Ethiopia
                [7 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Global Health and Population, , Harvard T.H. Chan School of Public Health, ; Boston, MA 02115 USA
                Author information
                http://orcid.org/0000-0003-3806-2453
                Article
                219
                10.1186/s12962-020-00219-7
                7374878
                32704237
                169bea79-08f6-419f-91ef-11194f00e922
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 12 February 2020
                : 14 July 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: OPP1162384
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Public health
                hepatitis b virus,vaccines,mother-to-child transmission,birth dose of hbv vaccine,cost-effectiveness analysis,sub-saharan africa,ethiopia

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